[Rockingham]

No, the reforms in anesthesiology were more comprehensive than changes in paperwork intended to frustrate trial lawyers by makingt malpractice harder to prove. The quality of care was improved and adverse patient events declined dramatically.

Anesthesiology equipment was radically redesigned to make common errors virtually impossible, things like making fittings incompatible and using color codes so that oxygen and anesthesia gas lines would not be confused. Manufacturers applied ergonomics and developed common protocols so that the intuitive feel and details of operation were similar even in machines from different manufacturers. Anesthesiology training and protocols were also revised to fit with the new equipment and to minimize errors.

The underlying concept was to regard the anesthesiologist as being like a pilot, with deadly serious decisions having to be made in seconds without time for analysis. That approach has made air travel extraordinarily safe. Notably, this took decades to recognize and apply to anesthesiology despite the benefits. My cynical side sees this as due to the risk of pilot death in aviation mishaps. Mere patient deaths did not provide sufficient incentive for anesthesiology reform, but years of financially ruinous malpractice premiums eventually did the trick.

In addition to malpractice, the broader problem is poor medical quality control. But that is beginning to be recognized, with the federal government prodding doctors toward improvement. Do not take my word for it: I'll close with an excerpt from a recent NYT article.

December 25, 2004
Program Coaxes Hospitals to See Treatments Under Their Noses
By GINA KOLATA

he federal government is now telling patients whether their local hospitals are doing what they should.

For now, the effort involves three common and deadly afflictions of the elderly - heart attacks, heart failure and pneumonia - and asks about lifesaving treatments that everyone agrees should be given but that hospitals and doctors often forget to give.

The expectation, though, is that this is just the beginning; other diseases, other treatments and surgery are next. Within a few years, individual doctors will be rated as well.

Using incentives like bonus pay and deterrents like public humiliation, it is a bold new effort by the federal government, along with organizations of hospitals, doctors, nurses, and health researchers, to push providers to use proven remedies for common ailments.

And it is a response to a sobering reality: lifesaving treatments often are forgotten while doctors and hospitals lavish patients with an abundance of care, which can involve expensive procedures of questionable value. The results are high costs, unnecessary medicine and wasted opportunities to save lives and improve health.

Simple things can fall through the cracks.

"In some ways, it's kind of scary," said Dr. Peter Gross, the chief of the department of internal medicine at Hackensack University Medical Center in New Jersey. "The doctor today is much too busy and has too much to remember."

The hospital ratings are being done by Medicare and posted on the Internet (www.cms.hhs.gov/quality/hospital/).

And already, hospitals are responding, often with shock, when they discover they have been forgetting some of the very treatments that can make a difference between life and death, or sickness and health.

At Duke University's hospital, for example, when patients arrived short of breath, feverish and suffering from pneumonia, their doctors monitored their blood oxygen levels and put them on ventilators, if necessary, to help them breathe.

But they forgot something: patients who were elderly or had a chronic illness like emphysema or heart disease should have been given a pneumonia vaccine to protect them against future bouts with bacterial pneumonia, a major killer. None were.

All bacterial pneumonia patients should also get antibiotics within four hours of admission. But at Duke, fewer than half did.

The doctors learned about their lapses when the hospital sent its data to Medicare. And they were aghast. They had neglected - in most cases simply forgotten - the very simple treatments that can make the biggest difference in how patients feel or how long they live.

* * *

[Bushforlife]

Dr. Gross has an opinion. He has that right.

So the State sets a standard which may or may not be a valid one. The State then says that we will impose that standard, measure that standard, and declare that non-compliance with that standard is "inadequate care".

I guess Dr. Gross agrees that being managed by the State is OK.

My contention is that the State is not there when you bring your sick child to the ER at 3 am, nor when you need an examination for your severe rectal pain. The State is real good, however, at imposing standards of care, even though the State Functionaries sit in offices from 9 to 5 and never put hands on patients. They of course find non-clinical doctors to "validate" these imposed standards, so they can say that these recommendations are from "doctors" who no doubt have imposing titles from the days that they actually treated patients. Some of those docs were probably pretty good, in the pre-penicillin era.

So much for "federal government prodding doctors toward improvement".

As for anesthesiologists, the improvements in technology you cite function merely to provide hard copy that everything was done correctly, making it harder for malpractice attorneys to unjustly point the finger at the doctors. The measures allow the docs to PROVE that proper safeguards were employed. Instead of just relying on their "word" that adequate oxygen was supplied to the patient at all times, a hard copy trace can be provided that PROVES it. The new measures you cite allow the doctor th document the good care he has been already providing for years, so the finger is not unjustly pointed at his "deep pockets" when bad outcomes occur.

Just because something is in the NYT doesn't mean it's true. Don't all of us on FR know that all too well?